If you’re easily distracted, struggle to complete even the simplest tasks, lose focus in the middle of a conversation or are constantly misplacing things, you could be one of the many adults with ADHD. Author and expert Russell Barkley, PhD, explains the unique challenges of this condition and how to get diagnosed...

About 9-11 million American adults struggle with adult attention deficit hyperactivity disorder (ADHD) — but the vast majority may not even know they have it. That’s because researchers are just beginning to understand adult ADHD symptoms, which are markedly different from those affecting children.

ADHD is a chronic disorder. That means it doesn’t go away with age, and there are no periods of remission. More than 99% of those who have it develop it by age 16.

“But ADHD changes with age,” said Russell Barkley, PhD, clinical professor of psychiatry at the Medical University of South Carolina and an ADHD specialist.

“By adulthood, hyperactivity is pretty much gone,” he says. “Some people feel an inner restlessness, but they aren’t climbing furniture or sliding down banisters.”

After studying thousands of adults with ADHD, experts recently rewrote rating scales, designed to help practitioners better diagnose and treat adult ADHD symptoms.

How many adults with ADHD are undiagnosed?We’ve surveyed thousands of adults, and only 10% of them have ever been diagnosed and treated for ADHD. Some were in treatment for another disorder. The symptoms of ADHD overlap with a couple disorders, such as bipolar disorder and borderline personality disorder.

What’s wrong with the tests currently used to diagnose adults with ADHD?
The American Psychiatric Association’s Diagnostic and Statistical Manual-IV criteria — known as the DSM — are based on a set of 18 symptoms. But they were designed for children.

What are adult ADHD symptoms? At its core, ADHD is a disorder of impulse control. Adults with ADHD were very impulsive as kids, and they continue to be that way in what they say, do and feel. They don’t think about future consequences.

Adults with ADHD also have great difficulties with time management and organization. They end up wasting a lot of time and procrastinating.

This is why they’re ill-prepared for deadlines. Adults with ADHD are chronically late for work, appointments and dates.

They’re often inflexible. An ability to reprioritize on the fly and shift to whatever is important at the moment is difficult. Whenever they get involved in an enjoyable activity they find it very difficult to get away from it. They often quit if there is no immediate payoff for what they’re about to do.

Adults with ADHD often can’t keep a job or sustain a relationship for more than three months.

Do adult ADHD symptoms differ between women and men? ADHD in adults is just as common in women as in men with the same symptoms. The differences have to do with their roles.

A stay-at-home mom may report more impairment in child rearing, while men and women who pursue careers and don’t have children or aren’t the primary caregiver report more problems at the office.

In the normal population, women are more likely to report depression and anxiety, and men more likely to report drug use and risk taking.

Do adult ADHD symptoms change with age?
We found a spike in difficulties with organization and problem solving in women at age 55. The only answer I have for that is perimenopause, which wreaks havoc with a woman’s functioning — particularly with her working memory (the ability to remember what you’re doing or hold in your mind goals of the moment and what you intend to do).

The frontal lobe of the brain is more sensitive to female hormones and when those change, women show a marked difference in working memory.

Why are so many adults with ADHD misdiagnosed? Many physicians don’t know that adults can have ADHD. It was previously believed that children outgrew it.

But in the last few years, organizations like CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), pharmaceutical companies and authors have made strides in acquainting the public and our colleagues with adult ADHD.

Do adult ADHD symptoms mimic those found in other disorders? Many disorders cause inattention, depression, anxiety and panic attacks. But if we look carefully, we can distinguish between them.

If you tell me you have trouble persisting toward a goal, completing tasks and resisting distractions, that would lead toward an ADHD diagnosis.

But if you told me you daydream, are spacey, easily confused or inwardly preoccupied and ruminative, that’s not ADHD. Those are symptoms we see with anxiety or post-traumatic stress disorder.

Do adults with ADHD have a different perception of how time passes?
People with ADHD misjudge time’s passage. They feel time is moving more slowly.

This leads them to feel they have more time than other people do, so they end up wasting a lot of time and procrastinating. This is why they are ill prepared for deadlines.

Time management is the single biggest predictor of your career success — not your IQ.

What’s the biggest challenge for adults with ADHD? ADHD is a biological disorder, but people view it as a moral failing or life choice.

People think adults with ADHD choose to be lazy, unproductive or squander their assets. Apart from the diagnosis not being recognized, the disorder isn’t viewed as a serious neurological condition like schizophrenia or bipolar disorder, which it is.

We have to get people to move toward viewing ADHD as a disability.

So bad parenting, sugary foods and too much TV and video games don’t cause ADHD? About two-thirds of ADHD is genetic. It runs in my family. My twin brother died in a car accident as a result of ADHD, and all three of my brother’s children have been diagnosed with the disorder.

[Studies have shown that] the remaining third [may have] acquired it from a brain injury, most often sustained in the womb.

Either they were born prematurely, or their mothers smoked and drank a lot, or had multiple infections or respiratory distress during pregnancy.

What are some strategies for managing adult ADHD symptoms?
First, you need a good evaluation. Call the local university psychology department or medical school psychiatry department and ask if they have clinics or faculty members that specialize in the disorder.

If not, contact a CHADD chapter to see if other members know which local professionals are experts on ADHD. Or contact the state psychology or psychiatry associations, which usually have a list of members and their specialties.

Third, consider medications. They reduce adult ADHD symptoms and impairments in major life activities that arise from those symptoms. They achieve this by affecting brain neurotransmitters and nerve-cell functioning.

Each drug does it somewhat differently than the others. Their effects last from 3-12 hours, depending on the drug and delivery system.

Fourth, we help you restructure your home life to compensate for ADHD. This may mean reorganizing your desk or going back for an assessment for a different job.

And finally, learning how to modify your behavior is important. There are formal programs for training adults with ADHD in executive functioning. They all deal with time management, self-motivation, regulating emotions, planning and problem solving.

You said it’s important that adults with ADHD have a sense of humor. Why?
With any disorder, you can get depressed and ruminate and beat yourself up. Or you can do what a lot of other disabled people do, which is grieve the loss of their ability, but ultimately reach acceptance.

Trying to maintain some humor and perspective can ease the burden and keep you from becoming depressed over difficulties it may cause.

Just as humor is good for one’s physical health and sense of well-being for the average person, it’s a good strategy to use, especially if one is disabled, to ward off demoralization and even depression.

How Much Do You Know About ADHD?Do you battle inattention and restlessness? You could have attention deficit hyperactivity disorder (ADHD). About 8-9 million adults have ADHD. Many adults are unaware of their disorder, as it was never diagnosed in childhood. Find out with this quiz how much you know about this common disorder.

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